@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

<http://hl7.org/fhir/us/davinci-pas/Bundle/PASClaimInquiryResponseBundleExample> a fhir:Bundle ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "PASClaimInquiryResponseBundleExample"] ; # 
  fhir:meta [
     fhir:profile ( [
       fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-inquiry-response-bundle"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-inquiry-response-bundle>
     ] )
  ] ; # 
  fhir:language [ fhir:v "en"] ; # 
  fhir:identifier [
     fhir:system [
       fhir:v "http://example.org/SUBMITTER_TRANSACTION_IDENTIFIER"^^xsd:anyURI ;
       fhir:l <http://example.org/SUBMITTER_TRANSACTION_IDENTIFIER>
     ] ;
     fhir:value [ fhir:v "5269367" ]
  ] ; # 
  fhir:type [ fhir:v "collection"] ; # 
  fhir:timestamp [ fhir:v "2005-05-02T11:01:00+05:00"^^xsd:dateTime] ; # 
  fhir:entry ( [
     fhir:fullUrl [
       fhir:v "http://example.org/fhir/ClaimResponse/PASClaimInquiryResponseExample"^^xsd:anyURI ;
       fhir:l <http://example.org/fhir/ClaimResponse/PASClaimInquiryResponseExample>
     ] ;
     fhir:resource ( <http://example.org/fhir/ClaimResponse/PASClaimInquiryResponseExample> )
  ] [
     fhir:fullUrl [
       fhir:v "http://example.org/fhir/Organization/UMOExample"^^xsd:anyURI ;
       fhir:l <http://example.org/fhir/Organization/UMOExample>
     ] ;
     fhir:resource ( <http://example.org/fhir/Organization/UMOExample> )
  ] [
     fhir:fullUrl [
       fhir:v "http://example.org/fhir/Organization/InsurerExample"^^xsd:anyURI ;
       fhir:l <http://example.org/fhir/Organization/InsurerExample>
     ] ;
     fhir:resource ( <http://example.org/fhir/Organization/InsurerExample> )
  ] [
     fhir:fullUrl [
       fhir:v "http://example.org/fhir/Coverage/InsuranceExample"^^xsd:anyURI ;
       fhir:l <http://example.org/fhir/Coverage/InsuranceExample>
     ] ;
     fhir:resource ( <http://example.org/fhir/Coverage/InsuranceExample> )
  ] [
     fhir:fullUrl [
       fhir:v "http://example.org/fhir/Patient/SubscriberExample"^^xsd:anyURI ;
       fhir:l <http://example.org/fhir/Patient/SubscriberExample>
     ] ;
     fhir:resource ( <http://example.org/fhir/Patient/SubscriberExample> )
  ] [
     fhir:fullUrl [
       fhir:v "http://example.org/fhir/Claim/ReferralAuthorizationExample"^^xsd:anyURI ;
       fhir:l <http://example.org/fhir/Claim/ReferralAuthorizationExample>
     ] ;
     fhir:resource ( <http://example.org/fhir/Claim/ReferralAuthorizationExample> )
  ] ) . # 

<http://example.org/fhir/ClaimResponse/PASClaimInquiryResponseExample> a fhir:ClaimResponse ;
  fhir:id [ fhir:v "PASClaimInquiryResponseExample"] ; # 
  fhir:meta [
     fhir:profile ( [
       fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse>
     ] )
  ] ; # 
  fhir:language [ fhir:v "en"] ; # 
  fhir:text [
     fhir:status [ fhir:v "extensions" ] ;
     fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ClaimResponse_PASClaimInquiryResponseExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse PASClaimInquiryResponseExample</b></p><a name=\"PASClaimInquiryResponseExample\"> </a><a name=\"hcPASClaimInquiryResponseExample\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-claiminquiryresponse.html\">PAS Claim Inquiry Response</a></p></div><p><b>identifier</b>: <code>http://example.org/PATIENT_EVENT_TRACE_NUMBER</code>/111099</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}\">Professional</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"Patient-SubscriberExample.html\">JOE SMITH  Male, DoB Unknown ( http://example.org/MIN#12345678901)</a></p><p><b>created</b>: 2019-07-20 11:01:00+0500</p><p><b>insurer</b>: <a href=\"Organization-InsurerExample.html\">Organization MARYLAND CAPITAL INSURANCE COMPANY</a></p><p><b>request</b>: <a href=\"Claim-ReferralAuthorizationExample.html\">Claim: extension = Urgent,; identifier = urn:trnorg:9012345678#111099; status = active; type = Professional; use = preauthorization; created = 2005-05-02 11:01:00+0500; priority = Normal</a></p><p><b>outcome</b>: Complete</p><blockquote><p><b>item</b></p><p><b>Item Requested Service Date</b>: 2005-05-02 --&gt; 2005-06-02</p><p><b>itemSequence</b>: 1</p><h3>Adjudications</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Category</b></td></tr><tr><td style=\"display: none\">*</td><td/><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></td></tr></table></blockquote><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-InsuranceExample.html\">Coverage: identifier = Member Number; status = active; subscriberId = 1122334455; relationship = Self</a></td></tr></table></div>"^^rdf:XMLLiteral ]
  ] ; # 
  fhir:identifier ( [
     fhir:system [
       fhir:v "http://example.org/PATIENT_EVENT_TRACE_NUMBER"^^xsd:anyURI ;
       fhir:l <http://example.org/PATIENT_EVENT_TRACE_NUMBER>
     ] ;
     fhir:value [ fhir:v "111099" ] ;
     fhir:assigner [
       fhir:identifier [
         fhir:system [
           fhir:v "http://example.org/USER_ASSIGNED"^^xsd:anyURI ;
           fhir:l <http://example.org/USER_ASSIGNED>
         ] ;
         fhir:value [ fhir:v "9012345678" ]
       ]
     ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
     fhir:coding ( [
       fhir:system [
         fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ;
         fhir:l <http://terminology.hl7.org/CodeSystem/claim-type>
       ] ;
       fhir:code [ fhir:v "professional" ]
     ] )
  ] ; # 
  fhir:use [ fhir:v "preauthorization"] ; # 
  fhir:patient [
     fhir:l <http://hl7.org/fhir/us/davinci-pas/Patient/SubscriberExample> ;
     fhir:reference [ fhir:v "Patient/SubscriberExample" ]
  ] ; # 
  fhir:created [ fhir:v "2019-07-20T11:01:00+05:00"^^xsd:dateTime] ; # 
  fhir:insurer [
     fhir:l <http://hl7.org/fhir/us/davinci-pas/Organization/InsurerExample> ;
     fhir:reference [ fhir:v "Organization/InsurerExample" ]
  ] ; # 
  fhir:request [
     fhir:l <http://hl7.org/fhir/us/davinci-pas/Claim/ReferralAuthorizationExample> ;
     fhir:reference [ fhir:v "Claim/ReferralAuthorizationExample" ]
  ] ; # 
  fhir:outcome [ fhir:v "complete"] ; # 
  fhir:item ( [
     fhir:extension ( [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate>
       ] ;
       fhir:value [
         a fhir:Period ;
         fhir:start [ fhir:v "2005-05-02"^^xsd:date ] ;
         fhir:end [ fhir:v "2005-06-02"^^xsd:date ]
       ]
     ] ) ;
     fhir:itemSequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:adjudication ( [
       fhir:extension ( [
         fhir:extension ( [
           fhir:url [
             fhir:v "number"^^xsd:anyURI ;
             fhir:l fhir:number
           ] ;
           fhir:value [
             a fhir:String ;
             fhir:v "AUTH0001"
           ]
         ] [
           fhir:url [
             fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode"^^xsd:anyURI ;
             fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode>
           ] ;
           fhir:value [
             a fhir:CodeableConcept ;
             fhir:coding ( [
               fhir:system [
                 fhir:v "https://codesystem.x12.org/005010/306"^^xsd:anyURI ;
                 fhir:l <https://codesystem.x12.org/005010/306>
               ] ;
               fhir:code [ fhir:v "A1" ] ;
               fhir:display [ fhir:v "Certified in total" ]
             ] )
           ]
         ] ) ;
         fhir:url [
           fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"^^xsd:anyURI ;
           fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction>
         ]
       ] ) ;
       fhir:category [
         fhir:coding ( [
           fhir:system [
             fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ;
             fhir:l <http://terminology.hl7.org/CodeSystem/adjudication>
           ] ;
           fhir:code [ fhir:v "submitted" ]
         ] )
       ]
     ] )
  ] ) ; # 
  fhir:insurance ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:focal [ fhir:v true ] ;
     fhir:coverage [
       fhir:l <http://hl7.org/fhir/us/davinci-pas/Coverage/InsuranceExample> ;
       fhir:reference [ fhir:v "Coverage/InsuranceExample" ]
     ]
  ] ) . # 

<http://hl7.org/fhir/us/davinci-pas/Patient/SubscriberExample> a fhir:Us .

<http://hl7.org/fhir/us/davinci-pas/Organization/InsurerExample> a fhir:Us .

<http://hl7.org/fhir/us/davinci-pas/Claim/ReferralAuthorizationExample> a fhir:Us .

<http://hl7.org/fhir/us/davinci-pas/Coverage/InsuranceExample> a fhir:Us .

<http://example.org/fhir/Organization/UMOExample> a fhir:Organization ;
  fhir:id [ fhir:v "UMOExample"] ; # 
  fhir:meta [
     fhir:profile ( [
       fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor>
     ] )
  ] ; # 
  fhir:language [ fhir:v "en"] ; # 
  fhir:text [
     fhir:status [ fhir:v "generated" ] ;
     fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_UMOExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization UMOExample</b></p><a name=\"UMOExample\"> </a><a name=\"hcUMOExample\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-requestor.html\">PAS Requestor Organization</a></p></div><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/6.2.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/8189991234</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/98 X3}\">X3</span></p><p><b>name</b>: DR. JOE SMITH CORPORATION</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>"^^rdf:XMLLiteral ]
  ] ; # 
  fhir:identifier ( [
     fhir:system [
       fhir:v "http://hl7.org/fhir/sid/us-npi"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/sid/us-npi>
     ] ;
     fhir:value [ fhir:v "8189991234" ]
  ] ) ; # 
  fhir:active [ fhir:v true] ; # 
  fhir:type ( [
     fhir:coding ( [
       fhir:system [
         fhir:v "https://codesystem.x12.org/005010/98"^^xsd:anyURI ;
         fhir:l <https://codesystem.x12.org/005010/98>
       ] ;
       fhir:code [ fhir:v "X3" ]
     ] )
  ] ) ; # 
  fhir:name [ fhir:v "DR. JOE SMITH CORPORATION"] ; # 
  fhir:address ( [
     fhir:line ( [ fhir:v "111 1ST STREET" ] ) ;
     fhir:city [ fhir:v "SAN DIEGO" ] ;
     fhir:state [ fhir:v "CA" ] ;
     fhir:postalCode [ fhir:v "92101" ] ;
     fhir:country [ fhir:v "US" ]
  ] ) . # 

<http://example.org/fhir/Organization/InsurerExample> a fhir:Organization ;
  fhir:id [ fhir:v "InsurerExample"] ; # 
  fhir:meta [
     fhir:profile ( [
       fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer>
     ] )
  ] ; # 
  fhir:language [ fhir:v "en"] ; # 
  fhir:text [
     fhir:status [ fhir:v "generated" ] ;
     fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_InsurerExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization InsurerExample</b></p><a name=\"InsurerExample\"> </a><a name=\"hcInsurerExample\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-insurer.html\">PAS Insurer Organization</a></p></div><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/6.2.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/1234567893</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/98 PR}\">PR</span></p><p><b>name</b>: MARYLAND CAPITAL INSURANCE COMPANY</p></div>"^^rdf:XMLLiteral ]
  ] ; # 
  fhir:identifier ( [
     fhir:system [
       fhir:v "http://hl7.org/fhir/sid/us-npi"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/sid/us-npi>
     ] ;
     fhir:value [ fhir:v "1234567893" ]
  ] ) ; # 
  fhir:active [ fhir:v true] ; # 
  fhir:type ( [
     fhir:coding ( [
       fhir:system [
         fhir:v "https://codesystem.x12.org/005010/98"^^xsd:anyURI ;
         fhir:l <https://codesystem.x12.org/005010/98>
       ] ;
       fhir:code [ fhir:v "PR" ]
     ] )
  ] ) ; # 
  fhir:name [ fhir:v "MARYLAND CAPITAL INSURANCE COMPANY"] . # 

<http://example.org/fhir/Coverage/InsuranceExample> a fhir:Coverage ;
  fhir:id [ fhir:v "InsuranceExample"] ; # 
  fhir:meta [
     fhir:profile ( [
       fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage>
     ] )
  ] ; # 
  fhir:language [ fhir:v "en"] ; # 
  fhir:text [
     fhir:status [ fhir:v "generated" ] ;
     fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_InsuranceExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage InsuranceExample</b></p><a name=\"InsuranceExample\"> </a><a name=\"hcInsuranceExample\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-coverage.html\">PAS Coverage</a></p></div><p><b>identifier</b>: Member Number/?ngen-9?</p><p><b>status</b>: Active</p><p><b>subscriberId</b>: 1122334455</p><p><b>beneficiary</b>: <a href=\"Patient-SubscriberExample.html\">JOE SMITH  Male, DoB Unknown ( http://example.org/MIN#12345678901)</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}, {https://codesystem.x12.org/005010/1069 18}\">Self</span></p><p><b>payor</b>: <a href=\"Organization-InsurerExample.html\">Organization MARYLAND CAPITAL INSURANCE COMPANY</a></p></div>"^^rdf:XMLLiteral ]
  ] ; # 
  fhir:identifier ( [
     fhir:type [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/v2-0203>
         ] ;
         fhir:code [ fhir:v "MB" ]
       ] )
     ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:subscriberId [ fhir:v "1122334455"] ; # 
  fhir:beneficiary [
     fhir:l <http://hl7.org/fhir/us/davinci-pas/Patient/SubscriberExample> ;
     fhir:reference [ fhir:v "Patient/SubscriberExample" ]
  ] ; # 
  fhir:relationship [
     fhir:coding ( [
       fhir:system [
         fhir:v "http://terminology.hl7.org/CodeSystem/subscriber-relationship"^^xsd:anyURI ;
         fhir:l <http://terminology.hl7.org/CodeSystem/subscriber-relationship>
       ] ;
       fhir:code [ fhir:v "self" ]
     ] [
       fhir:system [
         fhir:v "https://codesystem.x12.org/005010/1069"^^xsd:anyURI ;
         fhir:l <https://codesystem.x12.org/005010/1069>
       ] ;
       fhir:code [ fhir:v "18" ]
     ] )
  ] ; # 
  fhir:payor ( [
     fhir:l <http://hl7.org/fhir/us/davinci-pas/Organization/InsurerExample> ;
     fhir:reference [ fhir:v "Organization/InsurerExample" ]
  ] ) . # 

<http://example.org/fhir/Patient/SubscriberExample> a fhir:Patient ;
  fhir:id [ fhir:v "SubscriberExample"] ; # 
  fhir:meta [
     fhir:profile ( [
       fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber>
     ] )
  ] ; # 
  fhir:language [ fhir:v "en"] ; # 
  fhir:text [
     fhir:status [ fhir:v "generated" ] ;
     fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_SubscriberExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient SubscriberExample</b></p><a name=\"SubscriberExample\"> </a><a name=\"hcSubscriberExample\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-subscriber.html\">PAS Subscriber Patient</a></p></div><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">JOE SMITH  Male, DoB Unknown ( http://example.org/MIN#12345678901)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"A patient's military status.\"><a href=\"StructureDefinition-extension-militaryStatus.html\">Military Status</a></td><td colspan=\"3\"><span title=\"Codes:{https://codesystem.x12.org/005010/584 RU}\">RU</span></td></tr></table></div>"^^rdf:XMLLiteral ]
  ] ; # 
  fhir:extension ( [
     fhir:url [
       fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus>
     ] ;
     fhir:value [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:system [
           fhir:v "https://codesystem.x12.org/005010/584"^^xsd:anyURI ;
           fhir:l <https://codesystem.x12.org/005010/584>
         ] ;
         fhir:code [ fhir:v "RU" ]
       ] )
     ]
  ] ) ; # 
  fhir:identifier ( [
     fhir:system [
       fhir:v "http://example.org/MIN"^^xsd:anyURI ;
       fhir:l <http://example.org/MIN>
     ] ;
     fhir:value [ fhir:v "12345678901" ]
  ] ) ; # 
  fhir:name ( [
     fhir:family [ fhir:v "SMITH" ] ;
     fhir:given ( [ fhir:v "JOE" ] )
  ] ) ; # 
  fhir:gender [ fhir:v "male"] . # 

<http://example.org/fhir/Claim/ReferralAuthorizationExample> a fhir:Claim ;
  fhir:id [ fhir:v "ReferralAuthorizationExample"] ; # 
  fhir:meta [
     fhir:profile ( [
       fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim>
     ] )
  ] ; # 
  fhir:language [ fhir:v "en"] ; # 
  fhir:text [
     fhir:status [ fhir:v "extensions" ] ;
     fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Claim_ReferralAuthorizationExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Claim ReferralAuthorizationExample</b></p><a name=\"ReferralAuthorizationExample\"> </a><a name=\"hcReferralAuthorizationExample\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-claim.html\">PAS Claim</a></p></div><p><b>Level of Service Code</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1338 U}\">Urgent</span></p><blockquote><p><b>Transmission Identifiers</b></p><ul><li>applicationSenderCode: PROVIDERAPP</li><li>applicationReceiverCode: PAYERAPP</li><li>interchangeSenderID: PROVIDERID</li><li>interchangeReceiverID: PAYERID</li></ul></blockquote><p><b>identifier</b>: <code>urn:trnorg:9012345678</code>/111099</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}\">Professional</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"Patient-SubscriberExample.html\">JOE SMITH  Male, DoB Unknown ( http://example.org/MIN#12345678901)</a></p><p><b>created</b>: 2005-05-02 11:01:00+0500</p><p><b>insurer</b>: <a href=\"Organization-InsurerExample.html\">Organization MARYLAND CAPITAL INSURANCE COMPANY</a></p><p><b>provider</b>: <a href=\"Organization-UMOExample.html\">Organization DR. JOE SMITH CORPORATION</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>CareTeams</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>1</td><td><a href=\"PractitionerRole-ReferralPractitionerRoleExample.html\">PractitionerRole: telecom = ph: 4029993456</a></td></tr></table><h3>SupportingInfos</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Category</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes additionalInformation}\">Additional Information</span></td><td><a href=\"DocumentReference-DocumentReferenceExample.html\">DocumentReference: status = current; type = Physician procedure note; category = Clinical Note</a></td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm G89.4}\">Chronic pain syndrome</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-InsuranceExample.html\">Coverage: identifier = Member Number; status = active; subscriberId = 1122334455; relationship = Self</a></td></tr></table><blockquote><p><b>item</b></p><p><b>Service Item Request Type</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1525 SC}\">Specialty Care Review</span></p><p><b>Certification Type</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1322 I}\">Initial</span></p><p><b>Item Trace Number</b>: <code>http://example.org/ITEM_TRACE_NUMBER</code>/1122334</p><p><b>Authorization Number</b>: 1122445</p><p><b>Administration Reference Number</b>: 9988311</p><p><b>Requested Service</b>: <a href=\"ServiceRequest-ReferralRequestExample.html\">ServiceRequest Consultation</a></p><p><b>EPSDT Indicator</b>: false</p><p><b>Nursing Home Residential Status</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1345 2}\">Newly Admitted</span></p><p><b>Nursing Home Level of Care</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1337 2}\">Intermediate Care Facility (ICF)</span></p><p><b>Revenue Unit Rate Limit</b>: 100</p><p><b>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1</p><p><b>diagnosisSequence</b>: 1</p><p><b>category</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1365 3}\">Consultation</span></p><p><b>productOrService</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1365 3}\">Consultation</span></p><p><b>location</b>: <span title=\"Codes:{https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set 11}\">Office</span></p></blockquote></div>"^^rdf:XMLLiteral ]
  ] ; # 
  fhir:extension ( [
     fhir:url [
       fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode>
     ] ;
     fhir:value [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:system [
           fhir:v "https://codesystem.x12.org/005010/1338"^^xsd:anyURI ;
           fhir:l <https://codesystem.x12.org/005010/1338>
         ] ;
         fhir:code [ fhir:v "U" ] ;
         fhir:display [ fhir:v "Urgent" ]
       ] )
     ]
  ] [
     fhir:extension ( [
       fhir:url [
         fhir:v "applicationSenderCode"^^xsd:anyURI ;
         fhir:l fhir:applicationSenderCode
       ] ;
       fhir:value [
         a fhir:String ;
         fhir:v "PROVIDERAPP"
       ]
     ] [
       fhir:url [
         fhir:v "applicationReceiverCode"^^xsd:anyURI ;
         fhir:l fhir:applicationReceiverCode
       ] ;
       fhir:value [
         a fhir:String ;
         fhir:v "PAYERAPP"
       ]
     ] [
       fhir:url [
         fhir:v "interchangeSenderID"^^xsd:anyURI ;
         fhir:l fhir:interchangeSenderID
       ] ;
       fhir:value [
         a fhir:String ;
         fhir:v "PROVIDERID"
       ]
     ] [
       fhir:url [
         fhir:v "interchangeReceiverID"^^xsd:anyURI ;
         fhir:l fhir:interchangeReceiverID
       ] ;
       fhir:value [
         a fhir:String ;
         fhir:v "PAYERID"
       ]
     ] ) ;
     fhir:url [
       fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers>
     ]
  ] ) ; # 
  fhir:identifier ( [
     fhir:extension ( [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction>
       ] ;
       fhir:value [
         a fhir:CodeableConcept ;
         fhir:coding ( [
           fhir:system [
             fhir:v "https://www.usps.com/"^^xsd:anyURI ;
             fhir:l <https://www.usps.com/>
           ] ;
           fhir:code [ fhir:v "MA" ]
         ] )
       ]
     ] [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment>
       ] ;
       fhir:value [
         a fhir:String ;
         fhir:v "223412"
       ]
     ] ) ;
     fhir:system [
       fhir:v "urn:trnorg:9012345678"^^xsd:anyURI ;
       fhir:l <urn:trnorg:9012345678>
     ] ;
     fhir:value [ fhir:v "111099" ] ;
     fhir:assigner [
       fhir:identifier [
         fhir:system [
           fhir:v "http://example.org/USER_ASSIGNED"^^xsd:anyURI ;
           fhir:l <http://example.org/USER_ASSIGNED>
         ] ;
         fhir:value [ fhir:v "9012345678" ]
       ]
     ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
     fhir:coding ( [
       fhir:system [
         fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ;
         fhir:l <http://terminology.hl7.org/CodeSystem/claim-type>
       ] ;
       fhir:code [ fhir:v "professional" ]
     ] )
  ] ; # 
  fhir:use [ fhir:v "preauthorization"] ; # 
  fhir:patient [
     fhir:l <http://hl7.org/fhir/us/davinci-pas/Patient/SubscriberExample> ;
     fhir:reference [ fhir:v "Patient/SubscriberExample" ]
  ] ; # 
  fhir:created [ fhir:v "2005-05-02T11:01:00+05:00"^^xsd:dateTime] ; # 
  fhir:insurer [
     fhir:l <http://hl7.org/fhir/us/davinci-pas/Organization/InsurerExample> ;
     fhir:reference [ fhir:v "Organization/InsurerExample" ]
  ] ; # 
  fhir:provider [
     fhir:l <http://hl7.org/fhir/us/davinci-pas/Organization/UMOExample> ;
     fhir:reference [ fhir:v "Organization/UMOExample" ]
  ] ; # 
  fhir:priority [
     fhir:coding ( [
       fhir:system [
         fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ;
         fhir:l <http://terminology.hl7.org/CodeSystem/processpriority>
       ] ;
       fhir:code [ fhir:v "normal" ]
     ] )
  ] ; # 
  fhir:careTeam ( [
     fhir:extension ( [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope>
       ] ;
       fhir:value [
         a fhir:Boolean ;
         fhir:v true
       ]
     ] ) ;
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:provider [
       fhir:l <http://hl7.org/fhir/us/davinci-pas/PractitionerRole/ReferralPractitionerRoleExample> ;
       fhir:reference [ fhir:v "PractitionerRole/ReferralPractitionerRoleExample" ]
     ]
  ] ) ; # 
  fhir:supportingInfo ( [
     fhir:extension ( [
       fhir:extension ( [
         fhir:url [
           fhir:v "reportTypeCode"^^xsd:anyURI ;
           fhir:l fhir:reportTypeCode
         ] ;
         fhir:value [
           a fhir:CodeableConcept ;
           fhir:coding ( [
             fhir:system [
               fhir:v "https://codesystem.x12.org/005010/755"^^xsd:anyURI ;
               fhir:l <https://codesystem.x12.org/005010/755>
             ] ;
             fhir:code [ fhir:v "PY" ] ;
             fhir:display [ fhir:v "Physician's Report" ]
           ] )
         ]
       ] [
         fhir:url [
           fhir:v "transmissionMethod"^^xsd:anyURI ;
           fhir:l fhir:transmissionMethod
         ] ;
         fhir:value [
           a fhir:CodeableConcept ;
           fhir:coding ( [
             fhir:system [
               fhir:v "https://codesystem.x12.org/005010/756"^^xsd:anyURI ;
               fhir:l <https://codesystem.x12.org/005010/756>
             ] ;
             fhir:code [ fhir:v "EL" ] ;
             fhir:display [ fhir:v "Electronically Only" ]
           ] )
         ]
       ] [
         fhir:url [
           fhir:v "controlNumber"^^xsd:anyURI ;
           fhir:l fhir:controlNumber
         ] ;
         fhir:value [
           a fhir:String ;
           fhir:v "111222"
         ]
       ] [
         fhir:url [
           fhir:v "description"^^xsd:anyURI ;
           fhir:l fhir:description
         ] ;
         fhir:value [
           a fhir:String ;
           fhir:v "A procedure note included to provide details of what has been tried before the referral."
         ]
       ] ) ;
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-documentInformation"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-documentInformation>
       ]
     ] ) ;
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:category [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes"^^xsd:anyURI ;
           fhir:l <http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes>
         ] ;
         fhir:code [ fhir:v "additionalInformation" ]
       ] )
     ] ;
     fhir:value [
       a fhir:Reference ;
       fhir:l <http://hl7.org/fhir/us/davinci-pas/DocumentReference/DocumentReferenceExample> ;
       fhir:reference [ fhir:v "DocumentReference/DocumentReferenceExample" ]
     ]
  ] ) ; # 
  fhir:diagnosis ( [
     fhir:extension ( [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate>
       ] ;
       fhir:value [
         a fhir:Date ;
         fhir:v "2021-05-10"^^xsd:date
       ]
     ] ) ;
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:diagnosis [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:system [
           fhir:v "http://hl7.org/fhir/sid/icd-10-cm"^^xsd:anyURI ;
           fhir:l <http://hl7.org/fhir/sid/icd-10-cm>
         ] ;
         fhir:code [ fhir:v "G89.4" ]
       ] )
     ]
  ] ) ; # 
  fhir:insurance ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:focal [ fhir:v true ] ;
     fhir:coverage [
       fhir:l <http://hl7.org/fhir/us/davinci-pas/Coverage/InsuranceExample> ;
       fhir:reference [ fhir:v "Coverage/InsuranceExample" ]
     ]
  ] ) ; # 
  fhir:item ( [
     fhir:extension ( [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType>
       ] ;
       fhir:value [
         a fhir:CodeableConcept ;
         fhir:coding ( [
           fhir:system [
             fhir:v "https://codesystem.x12.org/005010/1525"^^xsd:anyURI ;
             fhir:l <https://codesystem.x12.org/005010/1525>
           ] ;
           fhir:code [ fhir:v "SC" ] ;
           fhir:display [ fhir:v "Specialty Care Review" ]
         ] )
       ]
     ] [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType>
       ] ;
       fhir:value [
         a fhir:CodeableConcept ;
         fhir:coding ( [
           fhir:system [
             fhir:v "https://codesystem.x12.org/005010/1322"^^xsd:anyURI ;
             fhir:l <https://codesystem.x12.org/005010/1322>
           ] ;
           fhir:code [ fhir:v "I" ] ;
           fhir:display [ fhir:v "Initial" ]
         ] )
       ]
     ] [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber>
       ] ;
       fhir:value [
         a fhir:Identifier ;
         fhir:system [
           fhir:v "http://example.org/ITEM_TRACE_NUMBER"^^xsd:anyURI ;
           fhir:l <http://example.org/ITEM_TRACE_NUMBER>
         ] ;
         fhir:value [ fhir:v "1122334" ]
       ]
     ] [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber>
       ] ;
       fhir:value [
         a fhir:String ;
         fhir:v "1122445"
       ]
     ] [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber>
       ] ;
       fhir:value [
         a fhir:String ;
         fhir:v "9988311"
       ]
     ] [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService>
       ] ;
       fhir:value [
         a fhir:Reference ;
         fhir:l <http://hl7.org/fhir/us/davinci-pas/ServiceRequest/ReferralRequestExample> ;
         fhir:reference [ fhir:v "ServiceRequest/ReferralRequestExample" ]
       ]
     ] [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator>
       ] ;
       fhir:value [
         a fhir:Boolean ;
         fhir:v false
       ]
     ] [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus>
       ] ;
       fhir:value [
         a fhir:CodeableConcept ;
         fhir:coding ( [
           fhir:system [
             fhir:v "https://codesystem.x12.org/005010/1345"^^xsd:anyURI ;
             fhir:l <https://codesystem.x12.org/005010/1345>
           ] ;
           fhir:code [ fhir:v "2" ] ;
           fhir:display [ fhir:v "Newly Admitted" ]
         ] )
       ]
     ] [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare>
       ] ;
       fhir:value [
         a fhir:CodeableConcept ;
         fhir:coding ( [
           fhir:system [
             fhir:v "https://codesystem.x12.org/005010/1337"^^xsd:anyURI ;
             fhir:l <https://codesystem.x12.org/005010/1337>
           ] ;
           fhir:code [ fhir:v "2" ] ;
           fhir:display [ fhir:v "Intermediate Care Facility (ICF)" ]
         ] )
       ]
     ] [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit>
       ] ;
       fhir:value [
         a fhir:Decimal ;
         fhir:v "100"^^xsd:decimal
       ]
     ] ) ;
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ;
     fhir:diagnosisSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ;
     fhir:category [
       fhir:coding ( [
         fhir:system [
           fhir:v "https://codesystem.x12.org/005010/1365"^^xsd:anyURI ;
           fhir:l <https://codesystem.x12.org/005010/1365>
         ] ;
         fhir:code [ fhir:v "3" ] ;
         fhir:display [ fhir:v "Consultation" ]
       ] )
     ] ;
     fhir:productOrService [
       fhir:coding ( [
         fhir:system [
           fhir:v "https://codesystem.x12.org/005010/1365"^^xsd:anyURI ;
           fhir:l <https://codesystem.x12.org/005010/1365>
         ] ;
         fhir:code [ fhir:v "3" ] ;
         fhir:display [ fhir:v "Consultation" ]
       ] )
     ] ;
     fhir:location [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:system [
           fhir:v "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set"^^xsd:anyURI ;
           fhir:l <https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set>
         ] ;
         fhir:code [ fhir:v "11" ]
       ] )
     ]
  ] ) . # 

<http://hl7.org/fhir/us/davinci-pas/Organization/UMOExample> a fhir:Us .

<http://hl7.org/fhir/us/davinci-pas/PractitionerRole/ReferralPractitionerRoleExample> a fhir:Us .

<http://hl7.org/fhir/us/davinci-pas/DocumentReference/DocumentReferenceExample> a fhir:Us .

<http://hl7.org/fhir/us/davinci-pas/ServiceRequest/ReferralRequestExample> a fhir:Us .

# -------------------------------------------------------------------------------------